Why don't we just vaccinate everyone under the age of 12?
The new vaccine against human papillomavirus, which became available last summer, could potentially prevent thousands of cases of cervical cancer. But doctors hope the vaccine will be able to prevent a less well-known, but potentially fatal, disease in gay men, anal cancer. The same strains of HPV cause both cancers. Although anal cancer can affect anyone, it is most common among men with histories of receptive anal intercourse — an annual rate of about 35 cases per 100,000, and perhaps twice that for those infected with H.I.V., which weakens the immune system.
The Food and Drug Administration approved the HPV vaccine last year for girls and women from 9 to 26 after studies indicated that it was extremely effective against infection by four of the dozens of strains of HPV, including the ones responsible for most cases of cervical and anal cancer, as well as genital and anal warts. “The cervix is similar biologically to the anus, so there’s plenty of hope that it will work there also,” said Dr. Joel Palefsky, a professor of medicine at the University of California, San Francisco. But he cautioned that its effectiveness against anal cancer remained to be proved.
The anal cancer rate for gay men is similar to cervical cancer rates before the advent of Pap smears, the test that can detect precancerous cell abnormalities. In recent years, some doctors who treat gay men have advised their patients to undergo anal Pap smears as part of routine preventive care. HPV is the most common sexually transmitted infection in the United States, with 6.2 million people infected each year, according to the Centers for Disease Control and Prevention, though many people clear the virus without having symptoms or knowing that they were infected.
Many gay men do not realize they have an elevated risk of anal cancer. David Maxim, an artist in San Francisco, said he had vaguely heard of HPV when he learned that he had anal cancer several years ago. “I had no idea about it because no one ever talked about it, although these days more gay men seem to be aware of it,” said Mr. Maxim, who was successfully treated with radiation and chemotherapy.
Regulators in Australia and the European Union have approved the vaccine, called Gardasil and made by Merck, for boys ages 9 to 15. They cited data showing that it produced an immune response in boys, though its effectiveness in preventing infection in sexually active men has not been proved...
Texas mandates cervical cancer vaccine for girls - Yahoo! News
Reuters/Yahoo
By Jim Forsyth
Fri Feb 2, 7:26 PM ET
Texas became the first U.S. state to require that all 11- and 12-year-old girls be vaccinated against the human papillomavirus, or HPV, a sexually transmitted disease that can cause cervical cancer, the governor's office said on Friday. Republican Gov. Rick Perry issued an executive order requiring the HPV vaccine be added to the list of vaccines that students must have to be enrolled in the state's public schools. The issue has generated fierce debate, with some religious organizations and parents' groups arguing such widespread vaccination programs could encourage premarital sex.
Perry said in a statement, "The HPV vaccine provides us with an incredible opportunity to effectively target and prevent cervical cancer." The vaccine is most effective in young women who are not yet sexually active. He added that parents could opt out of mandatory vaccinations for their children if they objected for reasons including religious beliefs....
Critics rip Perry's vaccine mandate
Governor rejects opponents' calls to reverse order
Feb. 6, 2007, 12:17PM
By JANET ELLIOTT
Copyright 2007 Houston Chronicle Austin Bureau
Gov. Rick Perry stood firm Monday against a political firestorm generated by his order that sixth-grade girls be inoculated against a sexually transmitted virus linked to cervical cancer.
Social conservatives from Texas to Washington called on Perry to reverse his order making Texas the first state to require the vaccine, saying the mandate makes sex seem permissible and that parents should be the ones to decide whether to immunize their daughters. And several Texas lawmakers expressed outrage at Perry for circumventing the legislative process. "This needs closer examination. How much will it cost the state?" asked Sen. Jane Nelson, chairwoman of the Senate Health and Human Services Committee, at a press conference. "Most importantly, as a mother of four daughters, I want to make sure our daughters' health is protected and parental rights are preserved." Nelson, R-Lewisville, asked Perry to reverse his order and said she also would ask the attorney general whether the Legislature has any recourse if he doesn't. Sen. Glenn Hegar, R-Katy, said he would file legislation to reverse Perry's order. There also is the question of what happens to several bills already filed to make the human papilloma virus shots mandatory for school enrollment.
Perry refused to rescind the executive order he issued Friday requiring the vaccine for girls ages 11 and 12 who are entering sixth grade in September 2008. Parents will be able to opt out their daughters, as they can for other required vaccines. In a statement, Perry addressed criticism that the vaccine could send a message that teenage sex is permissible. "Providing the HPV vaccine doesn't promote sexual promiscuity any more than providing the Hepatitis B vaccine promotes drug use," the governor said. "If the medical community developed a vaccine for lung cancer, would the same critics oppose it claiming it would encourage smoking?" [...]
Well, yes, I expect they would. They seem to think that virtue (speaking broadly) should be its own reward, and lack of virtue (speaking both broadly and specifically sexually) should bring its own punishment. And, honestly, I think you'd find a rather peculiar coalition of the unusual suspects on a lung cancer vaccine. But I digress.
So here's the thing: assuming that the vaccine proves effective in men, it's likely to prove effective in exactly the same way -- that is, in males who have not yet been exposed to the sexually transmitted form of HPV. And humans being what they are, once you get past 14-15 or so, all bets are off on whether or not someone is either sexually active or been exposed to the virus.
To be sure, you would have to propose the idea in an entirely different way. Even relative moderates are likely to be put off by the idea, "Hey, your little boy Norbert may have the butt sex someday. Why don't we vaccinate him against this disease so having the butt sex won't mean that he catches this nasty disease and maybe has to have his anus removed and poop in a bag for the rest of his possibly fairly brief life?" However true that may be, it's not likely to get parents to think that vaccinating little Norbert is a particularly necessary ideal.
On the other hand, if you frame it as the other half of a women's/girls health issue, you might actually get somewhere. If you say, "Hey, maybe when he's 16, 17, in college, whatever, Norbert maybe experiments, canoodles with a young woman, it goes maybe a little further than he'd like, but hey, it's just the once, no harm, no foul, he's only slighly nonvirginal, it's all still good. Except that perhaps the nice young woman, who maybe also went a little further than she'd planned once before, has been exposed to HPV, and neither she nor Norbert have been vaccinated. Now, after an appropriately re-virginizing period of abstinence, Norbert meets your daughter Annabelle, who has been as virtuous as the day is long. They marry. Only it turns out that Norbert never cleared the infection from his system, and because symptoms in men can be very slight, he never knew. And now your sweet Annabelle is dealing with cervical cancer. But if you get Norbert vaccinated when he's 10-12 years old, then all that gets prevented. And the side benefit is that if maybe he experiments once with the butt sex -- thinking, as young people apparently do these days, that no matter whose butt is involved, if it's only the butt sex, then everyone is still appropriately virginal -- or if, heaven forfend, he turns out to be a That Way Inclined, then you've done what you can to protect him from at least one thing."
You'd probably still have to leave off the whole butt sex idea, just to make it palatable to a lot of people. To be sure, the issue isn't simply that little Norbert might turn out to be gay; it's that most parents aren't prepared to think of their children as someday being sexual, especially when you have to start making decisions for them on those issues even before they're old enough to start thinking about it.
But still. If you just vaccinate everyone, it takes care of the problem for everyone. And it gets you around the issue, which nobody seems to quite be raising, that if you only vaccinate women against a disease that they get from men, somehow, it makes people think of women as the disease carriers, which is entirely wrong.
In any event, one small public health proposal, which would, no doubt, make Merck wet its corporate pants at the very thought of.
Posted by iain at February 06, 2007 02:21 PM
